Supplemental health care
In addition to the comprehensive coverage, supplemental health care benefits will include:
- Medications Included on the Drug Benefit List
- Medications not included on the Drug Benefit List
- Restrictions to the Medications on the Drug Benefit List
- Updating of the Drug Benefit List
- Accessing Medications
- The Role of the CF Drug Exception Centre
The CAF provides a wide variety of both prescription and non-prescription drugs to its members. These medications are defined in the Drug Benefit List. The medications on this list must generally be proven to provide a therapeutic effect. Other products, such as selected medical devices or supplies may also be included as Drug Benefits if there is evidence available to support their therapeutic value.
Drugs benefits will include, but not be limited to:
- drugs which normally require a prescription;
- drugs which may not legally require a prescription, but which are only available at an accredited pharmacy, and have known therapeutic value;
- replacement therapeutic nutrients provided that there is no other nutritional alternative to support the life of the member;
- injectable drugs, including allergy serum and vaccines;
- compounded prescriptions;
- vitamins and minerals listed in the CAF Drug Benefit List which are prescribed for the treatment of a chronic disease when the use of such products are proven to have therapeutic value; and
- drug delivery devices, such as those used to deliver asthma medications, which are integral to the product.
Products which do not have a proven therapeutic value will not be included in the Drug Benefit List. Products which fall outside the CAF Spectrum of Care will also not be reimbursed. As well, not all medications in a given therapeutic category will necessarily be included. If several different drug entities are available with similar mechanisms of action and similar therapeutic effects, a smaller selection of these medications is included. This will ensure rationalization of re-supply during deployment.
The following items are not considered to be benefits, and will not be funded:
- personal hygiene products (e.g. non-therapeutic soaps and shampoos, contact lens solutions, pumice stones, toothpaste and mouthwashes);
- agents of debatable therapeutic value (e.g. multivitamin preparations for general consumption, drugs for weight loss, herbal products, and homeopathic preparations); and
- drugs for purely cosmetic effects (e.g. drugs for male pattern baldness).
Certain medications are only approved for use in specific conditions, generally because their therapeutic potential may be limited or their side effects are more significant: these medications require Special Authorization to confirm that criteria for use have been met, and to thereby ensure optimal drug therapy. As well, other medications which are not routinely provided may be considered for use when the CAF Drug Benefit alternatives are not well tolerated or are ineffective. The use of these medications must be consistent with an evidence-based approach, and must be approved through the CF Drug Exception Centre (toll-free number 1-877-469-1003).
The Drug Benefit List is constantly being updated to reflect published literature and/or therapeutic guidelines. Such evidence is reviewed extensively by the Federal Pharmacy and Therapeutics (P&T) Committee, which includes independent physicians and pharmacists across Canada and representatives from various federal agencies. Based on such a review, this Committee makes recommendations as to whether medications should be added/removed from benefit lists. The CF P&T Committee then assesses this information, considering operational demands, and makes a decision regarding the status of the medications on the Drug Benefit List.
Prescriptions for medications should be filled at the local base pharmacy. If the base does not have a pharmacy, or if medication is required after-hours or in an emergency, the prescription may be filled at a community pharmacy. However, if a prescription is presented to a community pharmacy, a valid Blue Cross card will be required to process the prescription (if the community pharmacy will not honour the Blue Cross card, the prescription should be transferred to another pharmacy).
If the medication prescribed is an unrestricted benefit, the medication will be dispensed without complications. If the medication prescribed requires Special Authorization, the base pharmacist will attempt to determine if the criteria for use have been satisfied (if such a prescription is presented to a community pharmacy, the community pharmacist will contact the Blue Cross adjudication centre to determine if criteria for use have been met). If the Special Authorization criteria are not met, or if the drug prescribed is not on the Drug Benefit List, the CF Drug Exception Centre will contact the prescriber and/or pharmacist to discuss alternative treatment options or obtain further information to support the use of the non-benefit item.
CAF personnel whose workplace is located more than 50 km from a CAF pharmacy may have the option of enrolling in the OTC Benefit Card Program. This program allows eligible personnel to access certain non-prescription medications directly from a civilian pharmacy. To obtain more information regarding enrolment in this program, members may contact the OTC Card Program Administrator at (toll-free) 1-866-886-1304 or CSN 225-9557. The program information letter and the application form are found here and can be faxed to 613-901-1753.
The CF Drug Exception Centre is responsible for adjudicating requests for medication which are either not included as benefits or which do not satisfy the criteria for Special Authorization use. This Centre collects relevant information and reviews each case on an individual basis to determine the most appropriate drug therapy available. This Centre also liaises with Blue Cross and base pharmacies to ensure that Special Authorization criteria and medication access will be consistent for CAF members across Canada. Prescribers who anticipate concerns regarding approval of prescriptions may discuss other drug options with their base pharmacist, or alternately may contact the Drug Exception Centre directly at 1-877-469-1003 (toll-free).
- Eye Examination
- Entitled Personnel
- Entitlement to Prescription Eye Glasses
- Entitlement to Specialty Glasses
- Entitlement to Contact Lenses
- Obtaining frames and lenses
Eye Examination: All members of the Reg F and those entitled Res F Members (in accordance with QR&O 34.07) are entitled to one (1) eye examination every 24 calendar months by an outsourced provider (optometrist or ophthalmologist) for the purpose of assessing visual acuity to acquire prescription eyewear. Any additional requirements for vision assessments for occupational assessments must be preauthorized by the Canadian Forces Health Services Centre (CF H Svcs C). Members must take with them a CF 2007 – Canadian Forces Ophthalmology Case Record, available on the Defence Forms Catalogue or at the Medavie Blue Cross Client Member Portal, for the provider to record the assessment. This record must be returned to the CF H Svcs C for inputting into the health record.
Entitled Personnel: All members of the Reg F and those entitled Res F members (in accordance with QR&O 34.07) are entitled to optical services as outlined in the Canadian Forces Health Services (CF H Svcs) Policy and Guidance: Optical Supply and Services: Entitlement to Frames and Lenses, Policy # 4020-05.
Entitlement to Prescription Eye Glasses: Members are entitled to receive prescription eyewear to a maximum reimbursable amount every two years. The reimbursable amount can be found online at the Client Member Portal of the federal health claims processing service.
Generally, members will acquire one (1) pair of glasses, to include frame and prescription lens of their choice (clear or tinted, i.e. sunglasses) or new lenses in a current frame. Frames must be IAW CAF Dress Instruction. In addition, two (2) ballistic eyewear (BEW) inserts fitted with prescription lenses will be supplied to all entitled personnel for operational requirements. Recruits will be provided ballistic inserts while undergoing training and will be entitled to receive full vision benefits with entitlement to regular glasses at their posting location. Members posted out of country follow the same policy as above.
- Aircrew in the following MOSIDs are entitled to one (1) pair of prescription sunglasses every 24 months: 00183 Pilots, 00182 Air Combat Systems Officer, 00021 Flight Engineer, 00101 Search and Rescue Technician, 00184 Aerospace Control, 00337 Aerospace Control Operator (while employed in a designated control position), and 00185 Flight Test Engineer.
- Safety glasses that fit over prescription glasses would be the most appropriate protection paid by member’s unit and
- Respirator glasses (i.e. Friction Fit Devices) will be issued in accordance with established scales of issue or other entitlement documents.
Entitlement to Contact Lenses: Contact lenses that are necessary for therapeutic purposes, as prescribed by a consultant ophthalmologist/optometrist or for other medical requirement, are funded with prior approval of CF H Svcs Centre Senior Medical Authority. Contact lenses for refractive requirement or trade requirements are funded in accordance with CF H Svcs Gp Instr 4020-03, Optical Supply and Services: Entitlement to Contact Lenses.
Obtaining frames and lenses: Entitled members will obtain eye examination, frames and lenses through providers of their choice. The reimbursement amount can be found online at the Medavie Blue Cross Client Member Portal. Any amount over and above the authorized amount is at the member`s expense.
The item or service must be medically necessary for the treatment of disease or injury, and must be prescribed by a physician unless otherwise specified. Repairs or replacement of medical equipment will not be made at DND expense when it has been determined that the equipment has been misused. Eligible expenses are the reasonable and customary charges for the following items:
- Hearing Aids
- Orthopaedic Footwear (Military Pattern)
- Orthopaedic Footwear (Civilian Pattern)
- Trusses, Canes, Crutches, Splints, Casts, Cervical Collars and Off The Shelf Braces
- Custom Made Braces
- Elasticized Support Stockings
- Bandages and Surgical Dressings
- Orthopaedic Brassieres
- Ostomy Supplies, Catheters and Drainage Bags
- Prosthesis and Implants
- Needles, Syringes, and Chemical Diagnostics Aids
- Insulin Pumps and Associated Equipment
- Blood Glucose Monitors
- Durable Equipment
- Fertility Services
- Third Party Medical Services
- Laser Treatment of Dermatologic Conditions
Orthopaedic Footwear (Military Pattern), including modification when authorized by the HCC, once every twelve months, expenses: for other than initial entitlement, the member will pay the price of the equivalent military footwear (unless the footwear is normally issued on a no cost replacement basis).
Orthopaedic Footwear (Civilian Pattern), including athletic footwear, may be modified at public expense when prescribed and approved in accordance with the regulations for military pattern orthopaedic footwear. Individuals may have a maximum of two pairs of shoes, one pair of athletic shoes and one pair of boots, modified per year. Eligible persons must however, purchase the footwear at their own expense. DND shall only pay for modifications.
- breast prostheses following mastectomy, and replacement, but not within 24 months of the last purchase for the same side;
- temporary artificial limbs; and
- permanent artificial limbs and replacement thereof, but not within:
- 60 months from the last purchase of the same limb in the case of a member over 21 years of age, unless medically proven that growth or shrinkage of the surrounding tissue requires replacement of the existing prosthesis at an earlier date; or
- 12 months from the last purchase of the same limb in the case of a member 21 years of age or less.
Durable Equipment, manufactured specifically for medical use, which is required for therapeutic use in the patient's private residence and is recommended by the HCC, may be rented or purchased. Eligible durable equipment includes, but is not limited to, items such as wheelchairs, walkers, hospital beds, apnea monitors and alarm systems for anuretic patients. Reimbursement will be limited to the cost of non-motorized equipment unless medically proven that the patient requires motorized equipment.
Note: Any type of aid to daily living which is not a recognized form of medical treatment or any equipment that is not specifically designed for medical use is not an eligible benefit. Also refer to section on Assistive Device and Adaptive Equipment.
- In-Vitro Fertilization (IVF) and Intrauterine Insemination (IUI):
- As of 26 February 2019, a medical diagnosis of infertility with associated bilateral fallopian tube obstruction is no longer required to be eligible for fertility services. (CANFORGEN 029/19 – changes to fertility services eligibility in the CAF)
- Eligibility for IVF and/or IUI include all Regular Force, Reserve Force class C and B (greater than 180 days) women under the age of 43 years.
- CAF funding for IVF includes one (1) cycle of IVF (retrieval of eggs and one at a time transfer of all viable embryos) per lifetime (similar to Ontario provincial standards). Consultation and investigations for fertility services are included and are referred to the provincial health clinics when available.
- CAF members considering fertility services are requested to visit their primary care provider at a Canadian Force Health Services Centre (CF H Svcs C) for more information. Prior to a CAF member initiating any fertility services requiring funding under the CAF Spectrum of Care, a referral to a fertility clinic by a CF H Svcs C is required.
- The following services are not funded:
- Sperm donor or purchase fees
- Sperm washing / preparation for insemination
- Fees associated with surrogacy
- Egg or sperm storage or shipping fees
- Non-formulary medications associated with fertility services
- Optional testing (e.g. genetics testing)
- Any fertility services received outside of Canada
- Intracytoplasmic Sperm Injection (ICSI):
- The reimbursement cost for intracytoplasmic sperm injection (ICSI) utilized for male factor infertility is covered for CAF members only for three (3) cycles per lifetime at a max reimbursement cost of $2000 / cycle.
Note: Investigation and procedures for infertility are not funded when the infertility is the result of voluntary sterilization.
- proof of death;
- a medical-legal examination of a member injured on duty, or related litigation arising from events occurring while on duty;
- an examination required under a provincial mental patient's protection act;
- an examination required under a provincial public curatorship act; or
- an examination required under the Quebec Pension Plan or Canada Pension Plan
This would also include services which would be easily available to the majority of Canadians from their family physician for a nominal fee such as CAF physician-completion of forms, e.g. visa applications, adoption medical fitness assessment, insurance medicals, driver medicals and sport diving medicals. No fees for the physician's time will be charged to the CAF member for the provision of these services. However, where there are additional external costs associated with the provision of these services, such as charges for the use of outside-the-Clinic diagnostics, these costs will be the responsibility of the CAF member seeking the service. The CAF physician will nevertheless assist with ordering the required tests. In situations where the demand for CAF medical services is high, third party medical services would be accorded a lower priority than:
- The provision of medical care directly to patients; and
- The provision of medical support to CAF training and/or operations
Civil aviation medical examinations are not a benefit except when they are done by CAF flight surgeons for a CAF pilot and as part of a CAF-required assessment of the pilot's fitness to fly CAF aircraft. Psychological assessments required as part of custody disputes or any other examination, appraisal, testimony, or certification required by a member or a third party involved in any criminal litigation that arises from events occurring during off-duty periods, or for any litigation instigated privately by a member are not an eligible benefits.
- Laser treatment for port wine stain and malignant or pre-cancerous lesions, as recommended and performed by a dermatologist.
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